330 SPO Abstracts

107 THE HEMODYNAMIC EFFECTS OF ISOMETRIC EXERCISE DURING LATE PREGNANCY. I Van Hook x T. Easterling. B Schmucker, D. Braeteng, K. Carlson, B. DeLateur, P. Gill, T. Benedetti. Dept. Ob/Gyn, Univ WA, Seattle, WA. OBJECTIVE: The PLUpOse of this study was to measure the hemodynamic effects of isometric exercise in healthy women during late pregnancy. STUDY DESIGN: We performed non-invasive Doppler hemodynamics on ten healthy women carrying 25 to 36 week (31.1±.2.8 weeks) uncomplicated singleton gestations. Evaluation was undertaken before, during and after an 18 kg. isometric lower extremity extensor exercise. Measurements were thus made at rest, after one minute of exercise, and 3 minutes after completion of exercise to fatigue. Parameters evaluated were cardiac output (CO), mean arterial blood pressure (MAP), systemic vascular resistance (SYR), maternal pulse (HR) and stroke volume (SV). Data was analyzed using paired t test. An alpha value of 0.01 was utilized. RESULTS: HR, MAP, and SVR all increased during the performance of isometric effort (l:iR: 80.4±14.1 to 115.9±17.7 beats/min. (p='(XXl2); MAf:78.9±7.3 to 97.5±8.6 torr (p=.0004);.m: 923.8±148.2 to 1152±188.3 dyne.sec.cm-S (p=.0002)] . SY decreased (88.4±17.4 to 61.2±14.7mL (p=.OOO1)] during exercise. All values approached baseline when measured at recovery. ~ remained unchanged during [6.98±1.14 to 6.91±1.16 L/min (p=.7685)] and after [6.91±1.16 to 6.~0.92 L/min (p=.8089)] isolated isometric exercise. CONCLUSIONS: Isometric exercise during late pregnancy produces a demonstrable increase in in MAP. These effects are largely a result of an increase in SYR. CO remains essentially unchanged, secondary to reciprocal changes in HR and SV.

108 THE EFFECT OF AN ACUTE BOUT OF EXERCISE ON POSTPRANDIAL GLYCEMIC EXCURSION DURING PREGNANCY ~x, PA. GruppuSOX, R. TerryX, MW. Carpenter. Brown UniversityiWomen & Infants' Hospital, Providence, RI.

OBJECTIVE: To examine whether an acute bout of moderate intensity exercise reduces maternal glycemic excursion following a mixed nutrient mea. STUDY DESIGN: Four normal (NL) and two gestational diabetic (GOM) subjects between 26 and 40 weeks gestational age were enrolled. A cross over design compared the incremental area of the glycemic and insulin curves following a mixed nutrient meal (carbohydrate 50%, protein 20%, fat 30%) with, or without an exercise stress 14 hours prior to determination of fasting plasma glucose levels. Exercise consisted of riding a stationary bicycle for 30 minutes at a heart rate consistent with 70% V02max. Statistical analysis was performed by the Student's t·test RESULTS: Clinical characteristics of nonnal and gestationat diabetic subjects were comparable. Values with vs. without exercise for fasting glucose (NL: 77.5±3 vs. 78.0±2; GDM: 84±3 vs. 82±11), peak glucose (NL: 122.S±S vs. 124.5±5; GDM: 180±7 vs. 158.5±10), the area under the glycemic curve (NL: 4787;t.473 vs. 5294±84; GDM: 10172±1146 vs. 9203±91) did not differ. Preliminary data (N=4) show no evidence that insulin excursion is affected by exercise preceding a mixed nutrient meal. CONCLUSIONS: Exercise has been proposed as a treatment to reduce glycemia in gestational diabetes primarily based on trials in nonpregnant type "diabelics. Preliminary results from this study indicate that an acute bout of exercise may not conler any additional advantage to the blunted glycemic response observed when protein is added to a glycemic load.

January 1993 Am J Obstet Gynecol

109 DEFINING A NORMAL RANGE FOR CORD BLOOD GLYCOSYLATED HEMOGWBIN. B~tour, R. Hartnr, P. Ogburn, V. Fairbanks", P. O'Brie.r, E. Atki . Dept. OblGyn, Maternal Fetal Medicine, HematoklsY and Biootatistics, Mayo Oinic, Rocbester, MN. OBJEC'llVE: The goals of this study were (1) To define the normal range for rord blood glyro&ylated hemoglobin values in term neonates, and (2) To mate preliminaty oboervations about !be rord blood g1yoosylated hemoglobin values in infants born to diabetic mother>, relative to the newly established normat range. S1UDY DESIGN. Cord blood samples were collected from 229 consecutive term deliveries (202 samples from normal pregnancies). The samples were analyud for g1yoosylated hemoglobin content using affinity cotumn chromatoaraphy (Glyc.Affin GHb, Isolab Inc.). Maternal and infant charts were abltracted for information including demographics, complications of pregnancy and delivery, maternal and newborn weight and glucose monitoring durin, !be pregnancy. RESULTSI The 2.5th to 91.5th percentile for rord blood glycosylated hemoglobin values was defined .. the normal range. From the 202 normal pregnancie&, this translates to glyro&ylated hemoglobin values of 2.7·3.7% of total hemoglobin (mean = 3.1, s.d. = .31). Four normal pregnancies resulted in delivery of infants witb glycosylated hemoglobin values above this range. The chart review revealed borderline high values on prenatal glucose tolerance tests for at leasI two of these women. Of the 27 abnormal pregnancies, seven were complicated by gestational diabetes and treated with diet alone. All seven resulted in delivery of infants with normal glycosylated bemoglobin levels. Two of three pregnancies which were complicated by diabetes requiring insulin treatment, resulted in delivery of infants witb abnormal glyro&ylated bemoglobin levels. CONCLUSIONS: (1) There appear> to be a narrow and specific range of normal values Cor rord blood glycosylated bemoglobin in term neonates. (2) Fetal hyperinsulinemia does not consistently result in normalization of circulating fetal gluaJ6e levels. (3) Fetal hyperglycemia appear> to be reflected in elevated values of cord blood glyro&ylated hemoglobin.

110 VENTRlCUlAIl DIASTOLIC FUNC110N (VDF) IN n:roSES OF DIAKl1C M011IEItS (FDM), A DOl'PI..D IlCHOCARDIOOllAPlllC (ECHO) EVALUA110N. J.R. Stamer, J.e. Veille. DepL ObIGyn, Bowman Gray Sehool of Medicine, WUIItonoSalem, Ne. OBJEC'l1VF.I TraDlicnt hypertrophic cardiomyopathy (HeM) is common in infanta of diabetic mo!ben. Cbangea in VDF have been IUn in children with HeM. The PurpolC of this study WIll to compare VDF in FDM with teu-. of non-diabetic mothenl (FC). S1UDY DESIGN: Twenty.fM FDM and 21 Fe matched for gestational age (GA) were IlUdied with M-mode and pulled Doppler echo: Doppler <velocity wa<veforms were recorded below !be mitral (MY) and !be tricuspid (IV) val'Yes. Three to am cycles were diptalized and a<verage to determine time <velocity integral (iVI), paaM: filling portion of 1VI (E lVI), and active fining portion of 1VI (A 1VI). RESULTS. Unpaired t-teat wa. used (mean ± SD). ---- roM c-... • v ....

1V1Vl(em) S.9±1.9 S.0±0.8 <0.03 1V E 1Vl (ail) 2.S±1l.9 2.0±O.S <0.03 1V A 1Vl (em) 3.7±1.3 3.1±O.6 (NS)

1V: E 1VI/E lVl+A 1Vl O.41±0.07 0.40±0.06 (NS)

MYlVl(em~ S.S±1.7 4.S±1.2 <0.03

MYElVl (em) 2.4±0.9 J.9±0.8 <O.OS

MY AlVl(cm) 3.2±1.2 2.6±0.6 <O,OS

MY: E 1VI/E lVl+A 1Vl O.44±o.08 O.42±0'07 (NS)

A 1VI is BiSJlificantly greater than E 1VI for MY and 'IV in both groups. Septal thickMM, leptal thicknelll/polltcrior wan ratio, and fetal heart rate arc not BiSJlilicaatly dillerenL CONCLUSIONS. (1) E<ven without HeM, FDM ba<ve an increased totallVl and E 1VI acre. !be MY and 'IV as compared to Fe. (2) The A 1VI is incrcaaed in FDM only aclOlll !be MY. Evaluation of VDF in FDM with HCM is needed in future studies. (Supported by Grant #HL38296 from NIHLB).